Small area population disease burden

Small area health statistics has assumed increasing importance as the focus of population and public health moves to a more individualised approach of smaller area populations. Small populations and low event occurrence produce difficulties in interpretation and require appropriate statistical methods, including for age adjustment. There are also statistical questions related to multiple comparisons. Privacy and confidentiality issues include the possibility of revealing information on individuals or health care providers by fine cross-tabulations. Interpretation of small area population differences in health status requires consideration of migrant and Indigenous composition, socio-economic status and rural-urban geography before assessment of the effects of physical environmental exposure and services and interventions. Burden of disease studies produce a single measure for morbidity and mortality - disability adjusted life year (DALY) - which is the sum of the years of life lost (YLL) from premature mortality and the years lived with disability (YLD) for particular diseases (or all conditions). Calculation of YLD requires estimates of disease incidence (and complications) and duration, and weighting by severity. These procedures often mean problematic assumptions, as does future discounting and age weighting of both YLL and YLD. Evaluation of the Victorian small area population disease burden study presents important cross-disciplinary challenges as it relies heavily on synthetic approaches of demography and economics rather than on the empirical methods of epidemiology. Both empirical and synthetic methods are used to compute small area mortality and morbidity, disease burden, and then attribution to risk factors. Readers need to examine the methodology and assumptions carefully before accepting the results.

Hair morphine concentrations of fatal heroin overdose cases and living heroin users

Aims To compare heroin and other opiate use of heroin overdose fatalities, current street heroin users and drug-free therapeutic community clients. Design Hair morphine concentrations that assess heroin use and other opiate use in the 2 months preceding interview or death were compared between heroin overdose fatalities diagnosed by forensic pathologists (fOD) (n = 42), current street heroin users (CU) (n = 100) and presumably abstinent heroin users in a drug-free therapeutic community (TC) (n = 50). Setting Sydney, Australia. Findings The mean age and gender breakdown of the three samples were 32.3 years, 83% male (FOD), 28.7 years, 58% male (CU) and 28.6 years, 60% male (TC). The median blood morphine concentration among the FOD cases was 0.35 mg/l, and 82% also had other drugs detected. There were large differences between the three groups in hair morphine concentrations, with the CU group (2.10 ng/mg) having concentration approximately four times that of the FOD group (0.53 ng/mg), which in turn had a concentration approximately six times that of the TC group (0.09 ng/mg). There were no significant differences between males and females in hair concentrations within any of the groups. Hair morphine concentrations were correlated significantly with blood morphine concentrations among FOD cases (r = 0.54), and self-reported heroin use among living participants (r = 0.57). Conclusions The results indicate that fatal cases had a lower degree of chronic opiate intake than the active street users, but they were not abstinent during this period.

Outcome research in psychodynamic psychotherapy: Psychological, social and neuropsychological factors

While many studies have demonstrated positive outcomes from psychotherapy when it is practiced in a controlled research environment with carefully selected (or excluded) patient groups and rigid manualised therapy sessions there is a paucity of research regarding effective outcomes from psychotherapy as it is practiced in actual clinical conditions. The aim of this series of studies was to investigate outcomes, using an effectiveness approach, from psychodynamic psychotherapy as it is practiced by private psychiatrists. Three studies were planned. The aim of Study 1 was to provide standardized baseline measures on the following dimensions • Personal Demographic Information (PDI), • Target Symptoms and Disorders (TSD) including a neuropsychological profile • Inter and Intra Personal (IIP) factors, and, • General Functioning and Quality of Life (GFQoL) factors. Study 2 aimed to examine changes in patient characteristics during the course of treatment. Thus, baseline assessments were repeated at sixmonthly intervals to determine if therapy had been effective for individual patients. A third study was planned to assess the extent to which the results of significant outcome predictors could be replicated in different patient samples. Twenty-nine psychiatrists consented to refer patients with 20 patients having completed pre therapy assessments and six and 18-month follow-up questionnaires. The presentation of this research will focus on the interesting research methodology utilized, patient demographic characteristics and on the patient changes occurring over time on the dimensions of Defence Style (DSQ), Quality of Life (WHOQOL- Bref) and the severity of depression (BDI). The patient sample included 10 male and 10 female patients, whose ages ranged from 19 years to 66 years (mean = 43 years). While seven of the patients did not meet SCID-IV criteria for a current DSM-IV Axis 1 disorder, six patients met criteria for a current mood disorder, three for panic disorder, one patient each for PTSD, alcohol abuse and dependence, and 2 patients met current criteria for multiple Axis 1 disorders. The research is ongoing.

Can I have your attention please: Repressors and enhanced P3 to emotional stimuli

In four experiments ERPs to emotional (negative and positive) and neutral stimuli were examined as a function of participants’ trait anxiety and repressivedefensiveness. The experiments investigated the time course of attentional bias in the processing of such stimuli. Pictures of angry, happy, and neutral faces were used in two of the experiments and pictures ofmutilated, happy, and neutral faces were used in the others. ERP’s to emotional and neutral stimuli were recorded from parietal, temporal, and frontal sites. Analysis of the P3 component indicated that the peak magnitude of the P3 at the parietal and temporal sites reflected an interactive function of trait anxiety and defensiveness. Repressors (low reported anxiety, high defensiveness) showed a consistent pattern of greater P3 magnitude at the parietal and temporal sites for emotional faces (angry, happy, and mutilated) than did high-anxious and low-anxious participants. Participants did not differ in P3 magnitude when ERPs to neutral stimuli were investigated (e.g., a fixation cross). The findings indicate that Repressors dedicate greater processing resources to emotional material, as compared to neutral material, than either the high-anxious or low-anxious individuals. Results of the four experiments are discussed within the theoretical framework of Derakshan and Eysenck (1998). The importance of understanding the role of differences in information processing, in the experience and avoidance of emotional information, as a function of trait anxiety and defensiveness is emphasized.

'You can criticise because you care': Identification, constructiveness, and the intergroup sensitivity effect

Group criticisms judged to be reasonable in the mouth of an ingroup member are aggressively rejected when they stem from an outgroup member (the intergroup sensitivity effect). Mediational analyses suggest that this phenomenon is underpinned by an attributional bias; criticisms from insiders are more likely to be perceived as being motivated for constructive reasons than are criticisms from outsiders, thus arousing lower levels of defensiveness. But what if group members were to receive information that called into question the ingroup critic's commitment to the group? For example, if the ingroup critic was known to be a low identifier with their group, or used language to suggest that they were psychologically distancing themselves from their group, we might expect that ingroup critics will be downgraded as strongly as outgroup critics. Furthermore, it might be possible for people to turn an outgroup criticism into an ingroup criticism by making salient their shared identity at the superordinate level. Three experiments are described that provide support for each of these propositions.

ICT AND PRODUCTIVITY IN DEVELOPING COUNTRIES: NEW FIRM-LEVEL EVIDENCE FROM BRAZIL AND INDIA

This paper uses a unique new data set on manufacturing firms in Brazil and India to estimate production functions, augmented by information and communications technology (ICT). We find a strong positive association between ICT capital and productivity in both countries that is robust to several different specification tests. The paper also breaks new ground when using the Indian data to investigate the effect of the institutional and policy environment on ICT capital investment and productivity. We find that poorer infrastructure quality and labor market policy are associated with lower levels of ICT adoption, while poorer infrastructure is also associated with lower returns to investment.

Sonification supports eyes-free respiratory monitoring and task time-sharing

Three experiments explored the effectiveness of continuous auditory displays, or sonifications, for conveying information about a simulated anesthetized patient's respiration. Experiment 1 established an effective respiratory sonification. Experiment 2 showed an effect of expertise in the use of respiratory sonification and revealed that some apparent differences in sonification effectiveness could be accounted for by response bias. Experiment 3 showed that sonification helps anesthesiologists to maintain high levels of awareness of the simulated patient's state while performing other tasks more effectively than when relying upon visual monitoring of the simulated patient state. Overall, sonification of patient physiology beyond traditional pulse oximetry appears to be a viable and useful adjunct to visual monitors. Actual and potential applications of this research include monitoring in a wide variety of busy critical care contexts.

The link between prejudiced attitudes and discriminatory behaviour: The role of ingroup norms

In the present research, a reconceptualisation of the role of norms in the link between prejudiced attitudes and discriminatory behaviour — along the lines suggested by the social identity perspective — was tested. In the first study, group salience and group norm were manipulated. As expected, participants ascribed negative traits to significantly fewer Asian university students when they had received consensus information along these lines from a salient ingroup rather than from a salient outgroup. These results were replicated on a measure of strength of motivation to appear nonprejudiced. In a second study, group salience and norm were once again manipulated and strength of attitude and perceived group threat were measured. As predicted, people's negative attitudes towards globalisation were more likely to predict congruent behavioural responses to the extent that the group norm supported the attitude and group salience was high, particularly when high levels of group threat were perceived.

How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review

Objective To assess how well B-type natriuretic peptide (BNP) predicts prognosis in patients with heart failure. Design Systematic review of studies assessing BNP for prognosis m patients with heart failure or asymptomatic patients. Data sources Electronic searches of Medline and Embase from January 1994 to March 2004 and reference lists of included studies. Study selection and data extraction We included all studies that estimated the relation between BNP measurement and the risk of death, cardiac death, sudden death, or cardiovascular event in patients with heart failure or asymptomatic patients, including initial values and changes in values in response to treatment. Multivariable models that included both BNP and left ventricular ejection fraction as predictors were used to compare the prognostic value of each variable. Two reviewers independently selected studies and extracted data. Data synthesis 19 studies used BNP to estimate the relative risk of death or cardiovascular events in heart failure patients and five studies in asymptomatic patients. In heart failure patients, each 100 pg/ml increase was associated with a 35% increase in the relative risk of death. BNP was used in 35 multivariable models of prognosis. In nine of the models, it was the only variable to reach significance-that is, other variables contained no prognostic information beyond that of BNP. Even allowing for the scale of the variables, it seems to be a strong indicator of risk. Conclusion Although systematic reviews of prognostic studies have inherent difficulties, including die possibility of publication bias, the results of the studies in this review show that BNP is a strong prognostic indicator for both asymptomatic patients mid for patients with heart failure at all stages of disease.

Mammography screening participation: effects of a media campaign targeting Italian-speaking women

Objectives: To evaluate the effect of a radio and newspaper campaign encouraging Italian-speaking women aged 50-69 years to attend a population-based mammography screening program. Methods: A series of radio scripts and newspaper advertisements ran weekly in the Italian-language media over two, four-week periods. Monthly mammography screens were analysed to determine if numbers of Italian-speaking women in the program increased during the two campaign periods, using interrupted time series regression analysis. A survey of Italian-speaking women attending BreastScreen NSW during the campaign period (n=240) investigated whether individuals had heard or seen the advertisements. Results: There was no statistically significant difference in the number of initial or subsequent mammograms in Italian-speaking women between the campaign periods and the period prior to (or after) the campaign. Twenty per cent of respondents cited the Italian media campaign as a prompt to attend. Fifty per cent had heard the radio ad and 30% had seen the newspaper ad encouraging Italian-speaking women to attend BSNSW. The most common prompt to attend was the BSNSW invitation letter, followed by information or recommendation from a GP. Conclusion: Radio and newspaper advertisements developed for the Italian community did not significantly increase attendance to BSNSW. Implications: Measures of program effectiveness based on self-report may not correspond to aggregate screening behaviour. The development of the media campaign in conjunction with the Italian community, and the provision of appropriate levels of resourcing, did not ensure the media campaign's success.

Timing of rotator cuff activation during shoulder external rotation in throwers with and without symptoms of pain

Study Design: Fine-wire EMG rotator cuff onset time analysis in 2 matched groups of throwers with and without pain. Objective: To identify if there is a difference in the activation patterns of the rotator cuff muscles during a rapid shoulder external rotation task between throwers with and without pain. Background: The coordinated action of the rotator cuff is recognized as essential for glenohumeral joint control in the throwing athlete. Identification of abnormalities occurring in muscle activation patterns for injured athletes is relevant when prescribing rehabilitative exercises. Methods and Measures: Twelve throwers with shoulder pain were compared to a matched group of 11 asymptomatic throwers. Participants were matched for age, height, body mass, and habitual activity. Fine-wire EMG electrodes were inserted into the subscapularis, supraspinatus, and infraspinatus. EMG activity was measured during a reaction time task of rapid shoulder external rotation in a seated position. The timing of onset of EMG activity was analyzed in relation to visualization of a light (reaction time) and to the onset of infraspinatus activity (relative latency). Results: In the group with shoulder pain, the onset of subscapularis activity was found to be significantly delayed (reaction time, P = .0018; relative latency, P = .0005) from the onset of infraspinatus activity when compared to the control group. Conclusions: The presence of shoulder pain in these athletes was associated with a difference in the onset of subscapularis EMG activity during a rapid shoulder external rotation movement. This was an initial step in the understanding of the joint protection mechanisms of the glenohumeral joint and the problems that occur in throwers. This information may assist in providing future guidelines for more effective rehabilitation and prevention strategies for this condition.

Employee group memberships and organisational communication during organisational change

The preset study adopted an intergroup approach to information sharing and communication in three organisational samples during change. In Study 1, employees from a public hospital (N = 142) completed a survey measuring perceptions of organisational communication and strength of identification with the work unit and the organisation as a whole. Consistent with predictions, team members rated communication from double ingroup members (same work unit/same occupational group) more favourably than communication from partial group members (same work unit/different occupational group). Also as predicted, work unit identification was related to favourable ratings of work unit communication across occupational groups, whereas occupational identification was related to favourable ratings of work unit communication within occupational groups. In Study 2, strength of identification with three organisational groups was associated with positive ratings of communication among employees from the same public hospital (N = 189) and a military organisation (N = 2119). Based on these results, intergroup strategies for the management of information sharing and organisational communication during change are discussed.

Long-term cannabis use and mental healthy

The mental health consequences of the daily or near-dailyuseof cannabisoveryearsand decades remain uncertain, and are likely to remain so for some time given the difficul ties involved in investigating them. Never theless, there is sufficient evidence that its effects are neither as benign as proponents of its legalisation often argue, nor as malign as some partisans of continued prohibition claim (Hall et a!, 1994).